Heart Rate Fragmentation: A New Approach to the Analysis of Cardiac Interbeat Interval Dynamics.
Heart Rate Fragmentation: A New Approach to the Analysis of Cardiac Interbeat Interval Dynamics.
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DOI：
10.3389/fphys.2017.00255
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发表时间：
2017
影响因子：
4
通讯作者：
Goldberger AL
中科院分区：
文献类型：
--
作者：
Costa MD;Davis RB;Goldberger AL
背景：短期心率变异性（HRV）通常归因于生理性迷走神经张力调节。然而，随着年龄的增长和心血管疾病的发生，高短期HRV的出现，与神经自主-电生理控制系统的崩溃相一致，可能会使传统的HRV分析混淆。这种异常短期HRV的一个明显的动力学特征是心率加速征象的频繁变化，这里定义为心率碎片化。目的：目的是：(1)引入一套用于检测窦性心律分裂程度的指标；(2)在健康人群中检验心跳时间序列碎片化程度随年龄增长而增加的假设；(3)验证晚期冠状动脉疾病（CAD）患者的心跳时间序列比健康人更碎片化的假设；(4)将新碎片度量与短期HRV的标准时频域度量进行性能比较。方法：我们使用这些新引入的心率碎片指标，以及短期HRV的标准时域和频域指标，去趋势波动分析和样本熵分析了健康受试者和CAD患者的带注释的开放获取动态心电图记录（罗切斯特大学动态心电图库）。结果：在健康人群和冠心病患者中，心脏搏动间隔时间序列的碎片化程度随年龄的增加而显著增加。冠心病患者的碎片化程度高于健康人。在区分健康受试者和冠心病患者方面，心率碎片化指标优于传统的短期HRV指标，以及两种广泛使用的非线性指标——样本熵和去趋势波动分析短期指数。从正常到正常窦（NN）和心脏搏动间隔（RR）时间序列分析中获得了相同水平的区分。结论：本文引入的碎片化框架和相关指标构成了一种评估自由运行条件下短期HRV的新方法，它似乎克服了传统HRV分析的显着局限性。窦性心律节律的片段化可能为探索健康和疾病中控制心跳的神经自主-电生理网络的完整性提供新的动态生物标志物。
Background: Short-term heart rate variability (HRV) is most commonly attributed to physiologic vagal tone modulation. However, with aging and cardiovascular disease, the emergence of high short-term HRV, consistent with the breakdown of the neuroautonomic-electrophysiologic control system, may confound traditional HRV analysis. An apparent dynamical signature of such anomalous short-term HRV is frequent changes in heart rate acceleration sign, defined here as heart rate fragmentation. Objective: The aims were to: (1) introduce a set of metrics designed to probe the degree of sinus rhythm fragmentation; (2) test the hypothesis that the degree of fragmentation of heartbeat time series increases with the participants' age in a group of healthy subjects; (3) test the hypothesis that the heartbeat time series from patients with advanced coronary artery disease (CAD) are more fragmented than those from healthy subjects; and (4) compare the performance of the new fragmentation metrics with standard time and frequency domain measures of short-term HRV. Methods: We analyzed annotated, open-access Holter recordings (University of Rochester Holter Warehouse) from healthy subjects and patients with CAD using these newly introduced metrics of heart rate fragmentation, as well as standard time and frequency domain indices of short-term HRV, detrended fluctuation analysis and sample entropy. Results: The degree of fragmentation of cardiac interbeat interval time series increased significantly as a function of age in the healthy population as well as in patients with CAD. Fragmentation was higher for the patients with CAD than the healthy subjects. Heart rate fragmentation metrics outperformed traditional short-term HRV indices, as well as two widely used nonlinear measures, sample entropy and detrended fluctuation analysis short-term exponent, in distinguishing healthy subjects and patients with CAD. The same level of discrimination was obtained from the analysis of normal-to-normal sinus (NN) and cardiac interbeat interval (RR) time series. Conclusion: The fragmentation framework and accompanying metrics introduced here constitute a new way of assessing short-term HRV under free-running conditions, one which appears to overcome salient limitations of traditional HRV analysis. Fragmentation of sinus rhythm cadence may provide new dynamical biomarkers for probing the integrity of the neuroautonomic-electrophysiologic network controlling the heartbeat in health and disease.